Melih Parlak

Spontaneous resolution of vitreomacular traction: a case series

Three patients had unilateral vitreomacular traction (VMT) syndrome and the diagnosis was confirmed by spectral domain‐type optical coherence tomography (OCT). All patients were female aged 51, 55 and 62 years. All denied surgical intervention. In one patient, rapid spontaneous resolution of the vitreomacular traction with a complete posterior vitreous detachment (PVD) and a normal foveal contour was achieved within 15 days. In the remaining two cases a complete PVD could be detected as late as seven months after the initial presentation. In one, though the vitreomacular adhesion released spontaneously, there was a minimal residual epiretinal membrane. In all three eyes, visual acuity was considerably improved. Spontaneous, uneventful resolution has been rarely reported in the natural course of VMT but several recent studies with the aid of OCT have shown that spontaneous resolution might be more common than previously known. In light of our cases, we believe that there is still room to search for OCT clues in eyes with VMT to predict eyes with higher likelihood of spontaneous resolution, thereby avoiding unnecessary pharmacologic and/or surgical intervention.

Necrotic arachnidism of the eyelid due to Loxosceles rufescens spider bite

A 69-year-old woman was awakened with redness and swelling of the left upper eyelid a few days before her presentation. She also noticed a dead spider on her bed. Ophthalmic examination revealed severe left periorbital hyperemia, edema and a wide necrotic area on the upper eyelid. Systemic condition of the patient was well. She was hospitalized with the diagnosis of necrotic arachnidism of the left upper eyelid. Systemic corticosteroid and antibiotic treatment was commenced. No surgical intervention was carried out. A week later, whole upper eyelid was covered with a black eschar. This black eschar shrank with time, and it detached completely within 8 weeks and the lesion healed without a disfiguring scar. Meanwhile, the offending spider was identified as Loxosceles rufescens. Although rare, eyelid may be a biting site for Loxosceles spiders and a favorable result may be obtained with conservative management.

Splitting of a Dexamethasone Implant (Ozurdex) following the Injection

In this brief report, we share our observations on a splitted Dexamethasone implant (Ozurdex) which we discovered a week after the injection. It is likely that implant splitting neither changes the efficacy of the implant nor creates a mishap for the patient.

Retinal tears and rhegmatogenous retinal detachment after intravitreal injections: its prevalence and case reports.

PURPOSE To report the prevalence of postoperative retinal tear or rhegmatogenous retinal detachment secondary to intravitreal injections. METHODS Surgical and medical records of patients who received intravitreal injections at the practice of a single retina specialist from January 2004 to May 2013 and who were followed for at least 6 months were investigated retrospectively. RESULTS During the study period, a total of 3,907 intravitreal injections were performed in 1,049 eyes of 784 patients (416 males [47%]). The mean number of injections per eye was 3.72 ± 3.43 (range, 1-22). The mean age of the participants was 67.03 ± 13.56 (range, 5-94 years). The mean follow-up time was 31.98 ± 22.86 months (range, 6-144 months). Retinal break or rhegmatogenous retinal detachment occurred in 3 injections of 3 eyes, yielding an overall prevalence of 0.077% per injection and 0.29% per eye. CONCLUSIONS Retinal tear and rhegmatogenous detachment are rare complications of intravitreal injection. Precautions should be taken especially in patients having predisposing conditions, such as high myopia, or any other vitreoretinal disorders.

A Review of Intravitreal Treatment Alternatives Used as an Adjunctive Therapy in Coats' Disease: Parlak M et al. A review of intravitreal treatment alternatives used as adjunctive therapy in Coats' disease

Aim: To review the intravitreal treatment alternatives used as an adjunctive therapy in Coats’ disease. Context: The goal of therapy in Coats’ disease is essentially to obliterate all retinal nonperfused areas and ablate retinal vascular abnormalities in order to provide subretinal fluid resolution and regression of hard exudates whenever feasible. However, both anti-VEGFs and steroids are also administered intravitreally to improve the anatomic and functional outcome in cases with Coats’ disease by many clinicians nowadays. Methods: A comprehensive literature search was conducted in July 2015 to obtain all manuscripts related to Coats’ disease and particularly manuscripts on intravitreal injections were evaluated. Conclusions: The role of adjunctive intravitreal therapy whether with anti-VEGFs or steroids is still not well-established in Coats’ disease due to small number of studies previously published. Intravitreal pharmacotherapy may find a niche in the treatment armamentarium of Coats’ disease in the very near future.

Inverses Pseudohypopyon bei degenerativer Myopie@@@Inverted pseudohypopyon in degenerative myopia

Eine 57-jährige Patientin stellt sich mit einer akuten Sehverschlechterung am rechten Auge vor. Sie berichtet, dass sie schon seit ihrer Kindheit Brillenträgerin ist. Unter der Verdachtsdiagnose einer myopen Makulopathie wurde von einem niedergelassenen Augenarzt eine Fluoreszenzangio graphie durchgeführt, die keine chorioidale Neovaskularisation zeigte. Die Vorgeschichte der Patientin war bis auf komplikationslose Kataraktoperationen vor 4 Jahren unauffällig. Anamnestisch wurden keine systemischen Erkrankungen festgestellt.

Inverses Pseudohypopyon bei degenerativer Myopie

Eine 57-jährige Patientin stellt sich mit einer akuten Sehverschlechterung am rechten Auge vor. Sie berichtet, dass sie schon seit ihrer Kindheit Brillenträgerin ist. Unter der Verdachtsdiagnose einer myopen Makulopathie wurde von einem niedergelassenen Augenarzt eine Fluoreszenzangio graphie durchgeführt, die keine chorioidale Neovaskularisation zeigte. Die Vorgeschichte der Patientin war bis auf komplikationslose Kataraktoperationen vor 4 Jahren unauffällig. Anamnestisch wurden keine systemischen Erkrankungen festgestellt.

Inverted pseudohypopyon in degenerative myopia.

Eine 57-jährige Patientin stellt sich mit einer akuten Sehverschlechterung am rechten Auge vor. Sie berichtet, dass sie schon seit ihrer Kindheit Brillenträgerin ist. Unter der Verdachtsdiagnose einer myopen Makulopathie wurde von einem niedergelassenen Augenarzt eine Fluoreszenzangio graphie durchgeführt, die keine chorioidale Neovaskularisation zeigte. Die Vorgeschichte der Patientin war bis auf komplikationslose Kataraktoperationen vor 4 Jahren unauffällig. Anamnestisch wurden keine systemischen Erkrankungen festgestellt.

Long-Term Follow-Up of the Postoperative Macular Fold following the Vitreoretinal Surgery with Air Tamponade

A 64-year-old male who had a macula-on superior bullous retinal detachment in OD underwent scleral buckling, 20-gauge-pars plana vitrectomy, internal drainage of subretinal fluid with perfluorocarbon fluid, 360° endolaser and perflourocarbon-fluid-air exchange surgery. Patient sat upright immediately after the surgery for the night. At the first postoperative morning although the retina was attached, there was a macular fold extending toward the temporal retinal periphery. Patient denied further surgery. During the follow-up, retinal fold gradually became less visible and it could be noticeable only by fundus autoflorescence imaging at the sixth postoperative year with a subtle epiretinal membrane formation on the optical coherence tomographic section.

Spontaneous closure of the retinal pigment epithelial microrupture caused by a retained retrobulbar pellet

We describe a 48‐year‐old woman with a retained retrobulbar pellet and associated retinal pigment epithelial detachment. Spectral optical coherence tomography disclosed a focal microrupture of the retinal pigment epithelium. After two weeks of oral prednisolone treatment, the retinal pigment epithelial detachment was flattened and the microrupture was sealed. Optical coherence tomography is an important tool to elucidate the pathogenesis of blunt trauma‐related posterior pole changes.